Provider Demographics
NPI:1215992532
Name:ROBILLARD, STEPHANIE C (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:ROBILLARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 BEAVER DAM ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908
Mailing Address - Country:US
Mailing Address - Phone:603-674-7474
Mailing Address - Fax:
Practice Address - Street 1:425 ROUTE 125
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825
Practice Address - Country:US
Practice Address - Phone:603-664-9003
Practice Address - Fax:603-674-7474
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1402363A00000X, 363AM0700X
NH0503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077191Medicaid
MAP46781Medicare UPIN